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Narrating Care: Why the Words You Say Maximize the Impact of the Care You Provide

April 6, 2011

Often after I do a speaking presentation, people will come up to me to ask questions and share steps they are taking to improve performance. Some of the saddest moments are when it’s evident that someone is working very hard to serve patients and it appears many of the right steps are being taken—but the objective results are not there.

I’ve identified a common theme in these situations. Even when many of the correct steps are being implemented, one critical step often is not: explaining what you’re doing and why you’re doing it. Sometimes explanations have more impact than behaviors. That’s why narrating care is so powerful. Here are several examples:

Example 1: A hospital wanted to improve the patient’s perception of speed of direct admissions. Through process improvement it had reduced the average time to around 20 minutes from a previous average of over 40 minutes. Yet, patient perception of the speed of admission process stayed the same. The issue was that the change was not explained to patients—so they had no basis for comparison. It simply seemed slow.

The recommendation was to say to each patient: “The admission process you are going to go through used to take an average of 47 minutes. However, we’ve worked hard to speed up the process and now it should take less than 25 minutes. When you’ve completed the process, we’d like your feedback on it.” The hospital implemented these key words and patient perception of care went up.

Example 2: An Emergency physician told me the story that while he tried to make all the patients comfortable he was not explaining the actions he was taking. For example, “I want you to be as comfortable as possible—would you like a blanket?” or “I have ordered pain medication to make you more comfortable.”

While he and the other physicians had always done these behaviors, they had not connected the dots for the patient. Once they started doing so, the patient perception of care (satisfaction results) improved.

Example 3: A hospital’s HCAHPS result on noise was not good. To remedy the problem, the organization had put softer wheels on carts, eliminated paging, and even purchased quieter keyboards and put up signs asking people to keep noise levels down. Unfortunately, no improvement was experienced in the HCAHPS.

Here is what took place next. The staff explained to the patients and family members that they wanted the unit to be as quiet as possible so the patient could get rest. They even explained the steps they had taken, such as the softer wheels and the elimination of paging. They added: “While we do all we can, we are a hospital and some noise is inevitable as we’re caring for patients. Still, if it’s too noisy, please let the staff know and we will do all we can to keep things as quiet as possible.”

Guess what? Perception of quietness went up and noise went down.

I see healthcare professionals working very hard, taking many of the right steps, and I see their disappointment when those results are not there. Often, they end up trying even more actions—which may still not make a difference.

My suggestion is this: before you make even more changes, first take the time to better explain what you’re doing and why. The patient’s perception of care will improve and you’ll have a new appreciation for the true power of words.